Total Hip Replacement: Anterior Approach

What is total hip replacement with anterior approach?

A total hip replacement is a type of surgery. It replaces your hip joint with an artificial one. It is also called hip arthroplasty. Healthcare providers can do these procedures from behind the hip, to the side of the hip, or from in front of the hip. Total hip replacement with anterior approach refers to surgeries done from in front of the hip. These surgeries may also be called mini, modified, minimally invasive, or muscle-sparing surgeries.

Your hip is a ball-and-socket joint. Your thighbone (femur) bends inward near the hip. The upper end (head) has a round shape. The neck is the part that bends inward. The shaft is the long straight part.

The head of your femur fits into a cup-shaped cavity in your pelvis. This cavity is called the acetabulum. A flexible and tough protective tissue called the cartilage covers the inside of the acetabulum and the femoral head. Tissue lining your joint makes fluid that with the cartilage helps your bones slide easily against each other. Your muscles and ligaments (strong fibrous tissues) hold the joint together.

Orthopedic surgeons do hip replacement surgery to replace a damaged hip joint. The surgery also eases pain and helps improve movement. During the surgery, the surgeon will replace parts of your hip joint with artificial parts. The artificial hip can be metal or ceramic, or a combination of these. It may have a lining made of plastic, metal, or ceramic.

Using the anterior approach may allow your surgeon to do the surgery through a smaller surgical cut (incision). The cut is in the front of the hip rather than in the side or back, as in traditional hip replacements. Having your surgery done this way may have other possible advantages. These are:

• Less muscle trauma

• Less pain

• Earlier and easier recovery

• Less limping

• Shorter hospital stay

• Decreased chance of hip dislocations

These surgeries often take place under regional or general anesthesia.

Why might I need a total hip replacement with anterior approach?

If you are having problems with your hip, your healthcare provider may first advise other treatments. These include medicine for pain or inflammation, walking aids, and physical therapy. If you keep on having pain and have a hard time getting around, hip replacement surgery may be an option.

The purpose of most hip replacements is to treat pain and damage from arthritis. In osteoarthritis, long-term wear-and-tear damages the joint. In rheumatoid arthritis, inflammation causes pain, swelling, stiffness, and tissue damage. Other reasons for getting a hip replacement include:

• Broken or injured hip

• Bone that has died because it didn't get enough blood (avascular necrosis or osteonecrosis)

• Bone tumors

Total hip replacement with anterior approach is not an option for everyone. You may have other surgical choices, such as standard total hip replacement. Talk with your healthcare provider to see what makes sense for you.

What are the risks of total hip replacement with anterior approach?

Total hip replacement through the anterior approach is a fairly safe surgery. But it does carry some risks. Possible problems are:

• Infection

• Bleeding

• Blood clots

• Injury to nearby nerves

• Hip joint dislocation

• Leg length changes

• Joint loosening

There is also a slight risk that the surgery won't get rid of your pain or that it won't improve your mobility. In rare cases, people develop new pain or have less mobility after surgery. There may be other risks based on your age and health problems. Talk with your healthcare provider about your risks and concerns.

How do I get ready for a total hip replacement with anterior approach?

Your medical team can tell you how to get ready. Before your surgery, it's important to give a history of all your health problems. Let your healthcare provider know if you have any medicine allergies. Also let them know if you have a more recent problem, such as a sudden fever. Tell them if you are pregnant or think you might be pregnant.

Discuss any medicines you may be taking. This includes over-the-counter medicines, supplements, and illegal drugs. Ask if you need to stop taking any before your surgery.

In some cases, you may need other tests before your surgery. These might include:

• X-rays. These imaging tests provide information about your hip.

• MRI. This imaging test provides information about your hip and the tissues around it.

• Electrocardiogram. This is to make sure your heart rhythm is normal.

Follow any directions you are given for not eating or drinking before your surgery. You may also want to make some changes in your house so that your recovery is safer and smoother. For instance, you may want to add a handrail in your shower and remove any throw rugs.

What happens during a total hip replacement with anterior approach?

Your healthcare provider can tell you what to expect. An orthopedic surgeon with other surgical team members will do the surgery. An anesthesiologist will make sure you don't feel any pain during it. The surgery may take a few hours. In general:

• You will likely get general anesthesia so that you can sleep through the surgery. If you get regional anesthesia, you may also get medicine to make you relaxed and sleepy.

• Medical staff will closely watch your heart rate, blood pressure, and other vital signs before, during, and after the surgery.

• You may get antibiotics to help prevent infection.

• The skin around the surgical site will be cleaned. Any hair will be removed.

• The surgeon makes a cut in front of your hip joint.

• The surgeon separates your muscles to see your hip joint.

• The surgeon removes the upper part of your femur and the damaged cartilage and bone from your pelvis.

• The surgeon replaces your acetabulum and the head, neck, and part of the shaft of your femur with an artificial joint.

• The surgeon may take an X-ray to make sure the joint is in the right place.

• The surgeon or an assistant will close up the incision.

What happens after a total hip replacement with anterior approach?

After your surgery, you will go to a room to be watched while your anesthesia wears off. You will get medicine to ease pain. You may get medicine for nausea if needed.

After your initial recovery, you will go to your hospital room. You should be able to start eating and drinking again slowly. You may need to wear stockings or plastic devices to help prevent blood pooling in your legs. You may be told how to do breathing exercises and coughing to help prevent pneumonia.

Your surgeon may decide to get an X-ray or another imaging test to look at your hip. You may also need tests to check your blood counts.

Your surgeon will tell you when it is OK to start moving around and when you can put weight on your leg. Depending on how you are feeling, you may go home in a day or so.

You may be told what types of activities you can do and those you should avoid. As you start to get around, you may find that you need to use a cane or crutches. You may also need to work with a physical therapist to regain your mobility and strength. You should be able to do light activities within a couple of weeks. During this time, you may want to have extra help.

Some drainage from your incision for the first few days is normal. But tell your healthcare provider right away if you have:

• Increased redness, swelling, or drainage

• A high fever or chills

• Severe pain

• Pain that doesn’t decrease

Keep all your follow-up appointments. Follow all your healthcare provider’s instructions. If you have external stitches or staples, you will likely have them removed about a week or two after your surgery.

Your artificial hip may wear out or loosen over time. Over time, you may need another surgery. You may be able to extend the life of your implant by exercising regularly and taking safety measures to prevent falls. You may need to take antibiotics before some surgical procedures. They can reduce the risk of infection to your new hip.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results.

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure